Intro to Critical Care - Block 4 Flashcards

1
Q

What types of acute organ dysfunction fall under ICU?

A
  1. Shock
  2. Sepsis
  3. ADHF
  4. Acute tox
  5. Status epilepticus
  6. Stroke
  7. End organ damage from chronic dx
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2
Q

Who are closely monitoring the ICU?

A
  1. Trauma
  2. High risk surgeries (CABG, neurosurgical)
  3. High risk bleeding
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3
Q

What are the phases of crit illness?

A
  1. Rescue
  2. Optimization
  3. Stabilization
  4. De-escalation (step-down)
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4
Q

Route of med most common in ICU?

A

IV route:
1. Predicatable F
2. Fast onset
3. Rapid titratability
4. Wide therapeutic window

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5
Q

How is absorption affected in crit patients?

A
  1. Perfusion deficits
  2. Dysmotility
  3. Altered pH
  4. Loss in bowel integrity (perforation)
  5. Peripheral/gut edema
  6. Regional blood flow
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6
Q

Changes in Vd is affected by?

A
  1. FLuid shifts
  2. Tissue perfusion
  3. PPB
  4. Reduced tissue perfusion decreases distribution of hydrophilic medications
  5. Lipophilic (lipid-soluble) medications penetrate well into tissues independent of blood flow
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7
Q

What is shock liver?

A

Hypoxic hepatitis:
1. Acute cardiopulmonary failure
2. Transient increase in serum aspartate or alanine aminotransferase
3. Exclusion of other etiologies

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8
Q

When is augemented renal clearance used?

A

CrCl >120-160

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9
Q

How is distribution affected in crit patients?

A
  1. Largevolume resuscitation
  2. Capillary leak syndrome
  3. Ascites
  4. Mechanical ventilation
  5. Hypoalbuminemia
  6. ECMA
  7. Decreased a1 acid glycoprotein
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10
Q

How is metabolism affected in crit?

A
  1. Hepatic enzyme induction
  2. Augmented hepatic blood flow
  3. Hepatic enzyme inhibition
  4. Decreased hepatic blood flow
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11
Q

How is excretion affected by crit?

A
  1. Augmented renal clearance
  2. Extracorporeal removal
  3. AKI
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12
Q

What is MODS?

A

Potentially reversible physiologic derangement involving 2 or more organ systems not involved in disoder that resulted in ICU

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13
Q

What are you vital organs for survival?

A

Brain, kidney, heart, lung, liver

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14
Q

How do you interpret MOD score?

A

↑ MOD -> ↑ organ damage and mortality
MOD score of 0 is the best, 4 is the worst

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15
Q

How do you calculate R/P ratio?

A

(HR x right atrial pressure)/MAP

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16
Q

CV MODS description?

A
  1. Decreased peripheral vascular tone
  2. Increase capillary permeability 0> edema
  3. ALteration in regional bloof flow
  4. Microvascular plugging and stasis
  5. Myocardial depression
17
Q

Lung mods description?

A

Failure of normal gas exchange

18
Q

Kidney mods description?

A

Impariment in excretion

19
Q

Immunologic MODS description?

A

nosocomial ICU-acquired infection

20
Q

Prevention of MODs in lungs?

A

Ventilation

21
Q

Prevetnion of MODS in CV?

A

Restrict transfusion of packed red cells when hemoglobin is > 70

22
Q

MOD prevention in renal?

A

Avoidance of nephrotoxins

23
Q

Prevetnion of MODS in GI?

A

Stress ulcer prophylaxis with H2 blockers rather than sucralfate

Enteral nutrition

24
Q

MOD prevention in hematologic?

A

DVT prophylaxis

25
Q

What are inhaled meds for respiration? Advantages?

A

Bronchodilators (Combivent - Ipratropium/Albuterol), steroid, abx

  1. Rapid onset
  2. high lung tissue drug concentrations
  3. Limited tox
  4. No IV
26
Q

What is you most invasive way of delivering O2 to a patient?

A

Ventilation

27
Q

What is the sequence ofdrug in rapid sequence intubation?

A
  1. Sedative always goes first
  2. Neuromuscular blockers as a paralysis agent
28
Q

What are ex of continuous organ support?

A

Establishes a new steady state:
1. CRRT
2. ECMA

29
Q

What is an ex of intermittent organ support?

A

Changes medication dispostiton and elimination:
1. HD
2. TPE
3. ELSS

30
Q

What is ECMO?

A

Bypasses lungs: Deoxygenated blood is brained from the superior vena cava, pumped through and oxygenator, and delivered back into the body through the femoral artery

31
Q

What is TPE?

A

Plasma exchange that is a closed-circuit blood purification system that removes large molecules

32
Q

How are medications affected by TPE?

A

Alters the volume of distribution, protein binding, and clearance of a medication:
1. Human albumin replacement can increase the fraction of protein-bound medications
2. Removes drugs present in plasma

33
Q

What is ELSS?

A

Extracorporeal Liver Support System: dialysis for failing liver -> allow hepatocytes to recover or temporize until liver tranplants

34
Q

What are the components of an ICU check up?

A

Feeding
ANalgesia
Sedation
Thromboembolism prevention
Head of the bed elevation
Ulcer prophylaxis
Glucose control
Spontaneous breathing trial
Bowel function evaluation
Indwelling catheters (removal)
De-escalation of antimicrobial and other pharm

35
Q

What is PICS?

A

Post intensive care syndrome: complication of ICU surviorship where assessment is recommended within 2-4 weeks of discharge

36
Q
A